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First Aid: Step 2 CS > Differential & Work-up: Chest pain, Palpitations > Flashcards

Differential & Work-up: Chest pain, Palpitations Flashcards

1
Q

60 yo M presents with sudden onset of substernal heavy chest pain that has lasted for 30 minutes and radiates to the left arm. The pain is accompanied by dyspnea, diaphoresis, and nausea. He has a history of hypertension, hyperlipidemia, and smoking.

A
  1. Myocardial infarction (MI)
  2. GERD
  3. Angina
  4. Costochondritis
  5. Aortic dissection
  6. Pericarditis
  7. Pulmonary embolism
  8. Pneumothorax
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2
Q

WORK UP FOR:

  1. Myocardial infarction (MI)
  2. GERD
  3. Angina
  4. Costochondritis
  5. Aortic dissection
  6. Pericarditis
  7. Pulmonary embolism
  8. Pneumothorax
A
  1. ECG
  2. CPK-MB, troponin x 3
  3. CXR
  4. CBC
  5. Electrolytes
  6. Helical CT
  7. Echocardiography
  8. Cardiac catheterization
  9. D-dimer
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3
Q

20 yo African American F presents with acute onset of severe chest pain for a few hours. She has a history of sickle cell disease and multiple hospitalizations for pain and anemia management.

A
  1. Sickle cell disease: acute chest syndrome
  2. Pulmonary embolism
  3. Pneumonia
  4. MI
  5. Pneumothorax
  6. Aortic dissection
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4
Q

WORK UP FOR:

  1. Sickle cell disease: acute chest syndrome
  2. Pulmonary embolism
  3. Pneumonia
  4. MI
  5. Pneumothorax
  6. Aortic dissection
A
  1. CBC with reticulocyte count & peripheral smear
  2. LDH
  3. ABG
  4. D-dimer
  5. CXR
  6. CPK-MB, troponin
  7. ECG
  8. CTA-chest with IV contrast
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5
Q

45 yo F presents with a retrosternal burning sensation that occurs after heavy meals and when lying down. Her symptoms are relieved by antacids.

A
  1. GERD
  2. Esophagitis
  3. Peptic ulcer disease
  4. Esophageal spasm
  5. MI
  6. Angina
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6
Q

WORK UP FOR:

  1. GERD
  2. Esophagitis
  3. Peptic ulcer disease
  4. Esophageal spasm
  5. MI
  6. Angina
A
  1. ECG
  2. Barium swallow
  3. Upper endoscopy
  4. Esophageal pH
  5. monitoring
  6. H pylori stool antigen
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7
Q

55 yo M presents with retrosternal squeezing pain that lasts for 2 minutes and occurs with exercise. It is relieved by rest and is not related to food intake.

A
  1. Stable angina
  2. Esophageal spasm
  3. Esophagitis
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8
Q

WORK UP FOR:

  1. Stable angina
  2. Esophageal spasm
  3. Esophagitis
A
  1. ECG
  2. CPK-MB, troponin
  3. CXR
  4. CBC
  5. Electrolytes
  6. Exercise stress test
  7. Upper endoscopy/pH monitor
  8. Cardiac catheterization
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9
Q

34 yo F presents with retrosternal stabbing chest pain that improves when she leans forward and worsens with deep inspiration. She had a URI 1 week ago.

A
  1. Pericarditis
  2. Aortic Dissection
  3. MI
  4. Costochondritis
  5. GERD
  6. Esophageal Rupture
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10
Q

WORK UP FOR:

  1. Pericarditis
  2. Aortic Dissection
  3. MI
  4. Costochondritis
  5. GERD
  6. Esophageal Rupture
A
  1. ECG
  2. CPK-MB, troponin
  3. CXR
  4. Echocardiography
  5. CBC
  6. Upper endoscopy
  7. ESR
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11
Q

33 yo F presents with stabbing chest pain that worsens with deep inspiration and is relieved by aspirin. She had a URI 1 week ago. Chest wall tenderness is noted.

A
  1. Costochondritis
  2. Pneumonia
  3. MI
  4. Pulmonary embolism
  5. Pericarditis
  6. Pleurisy
  7. Muscle strain
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12
Q

WORK UP FOR:

  1. Costochondritis
  2. Pneumonia
  3. MI
  4. Pulmonary embolism
  5. Pericarditis
  6. Pleurisy
  7. Muscle strain
A
  1. ECG
  2. CXR
  3. CPK-MB, troponin
  4. CBC
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13
Q

70 yo F presents with acute onset of shortness of breath at rest and pleuritic chest pain. She also presents with tachycardia, hypotension, tachypnea, and mild fever. She is recovering from hip replacement surgery.

A
  1. Pulmonary embolism
  2. Pneumonia
  3. Costochondritis
  4. MI
  5. CHF
  6. Aortic dissection
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14
Q

WORK UP FOR:

  1. Pulmonary embolism
  2. Pneumonia
  3. Costochondritis
  4. MI
  5. CHF
  6. Aortic dissection
A
  1. D-dimer
  2. CTA-chest with IV contrast
  3. CXR
  4. ECG
  5. ABG
  6. CPK-MB, troponin
  7. CBC
  8. Electrolytes, BUN/Cr, glucose
  9. Doppler U/S-legs
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15
Q

55 yo M presents with sudden onset of severe chest pain that radiates to his back. He has a history of uncontrolled hypertension.

A
  1. Aortic dissection
  2. MI
  3. Pericarditis
  4. Esophageal rupture
  5. Esophageal spasm
  6. GERD
  7. Pancreatitis
  8. Fat embolism
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16
Q

WORK UP FOR:

  1. Aortic dissection
  2. MI
  3. Pericarditis
  4. Esophageal rupture
  5. Esophageal spasm
  6. GERD
  7. Pancreatitis
  8. Fat embolism
A
  1. TTE
  2. ECG
  3. CPK-MB, troponin
  4. CXR
  5. CBC
  6. Amylase, lipase
  7. CTA-chest with IV contrast
  8. MRI/MRA-aorta
  9. Aortic angiography
  10. Upper endoscopy
17
Q

70 yo diabetic M presents with episodes of palpitations and diaphoresis. He is on insulin.

A
  1. Hypoglycemia
  2. Cardiac arrhythmia
  3. Angina
  4. Hyperthyroidism
  5. Hyperventilation episodes
  6. Panic attack
  7. Pheochromocytoma
  8. Carcinoid syndrome
18
Q

WORK UP FOR:

  1. Hypoglycemia
  2. Cardiac arrhythmia
  3. Angina
  4. Hyperthyroidism
  5. Hyperventilation episodes
  6. Panic attack
  7. Pheochromocytoma
  8. Carcinoid syndrome
A
  1. Glucose
  2. CBC
  3. Electrolytes
  4. TSH
  5. ECG
  6. 24-hour urinary
  7. catecholamines
  8. 5-HIAA
19
Q

35 yo M presents with several episodes of palpitations, sweating, and rapid breathing. Episodes occur unexpectedly, and he does not recall any triggers. He has had four to five episodes per month for several months. Each episode lasts 2 to 3 minutes. He does not have any history of psychiatric illness except for separation anxiety as a child.

A
  1. Panic attack
  2. Generalized anxiety disorder
  3. Specific phobia
  4. Acute stress disorder
  5. Hyperthyroidism
  6. Substance abuse/dependence
  7. Pheochromocytoma
20
Q

WORK UP FOR:

  1. Panic attack
  2. Generalized anxiety disorder
  3. Specific phobia
  4. Acute stress disorder
  5. Hyperthyroidism
  6. Substance abuse/dependence
  7. Pheochromocytoma
A
  1. CBC
  2. Electrolytes
  3. TSH, FT4
  4. ECG
  5. Echocardiography
  6. Urine toxicology
  7. 24-hour urinary catecholamines
21
Q

19 yo F presents with episodic palpitations, especially during presentations in front of her class. Episodes include heart-pounding, facial blushing, and hand tremor. She also experiences excessive sweating and rapid breathing. She complains of intense worry and trouble sleeping for days or weeks before an upcoming social situation. Now she avoids all social events because she is afraid of humiliating herself.

A
  1. Social phobia
  2. Avoidant personality disorder
  3. Agoraphobia/ specific phobia
  4. Panic attack
  5. Generalized anxiety disorder
  6. Substance abuse/dependence
  7. Hyperthyroidism
22
Q

WORK UP FOR:

  1. Social phobia
  2. Avoidant personality disorder
  3. Agoraphobia/ specific phobia
  4. Panic attack
  5. Generalized anxiety disorder
  6. Substance abuse/dependence
  7. Hyperthyroidism
A
  1. CBC
  2. Electrolytes
  3. ECG
  4. TSH,FT4
23
Q

34 yo F presents with episodic palpitations accompanied by lightheadedness and sharp, atypical chest pain.

A
  1. Mitral valve prolapse
  2. Cardiac arrhythmia
  3. Panic attack
  4. Pheochromocytoma
24
Q

WORK UP FOR:

  1. Mitral valve prolapse
  2. Cardiac arrhythmia
  3. Panic attack
  4. Pheochromocytoma
A
  1. ECG
  2. TEE
  3. Event monitor
  4. Holter monitor
  5. 24-hour urinary catecholamines

First Aid: Step 2 CS (23 decks)

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